Health insurance will deconvention this Friday all Alliance Vision health centers for fraud estimated at more than 20 million euros. “This gives a deplorable image of the profession, we have the impression that all doctors are doing anything,” reacts the National Union of Ophthalmologists of France.
Doctor Thierry Bour, president of the National Union of Ophthalmologists of France (SNOF), estimates on franceinfo Friday July 21 that “most of the health centers that have opened” recently “have practices known to be fraudulent”in connection with the relaxation of the rules since 2018. Health insurance will deconvention 13 for a fraud estimated at more than 20 million euros, revealed franceinfo in the morning of Friday July 21.
>> Health insurance will deconvention all Alliance Vision health centers for fraud estimated at more than 20 million euros
franceinfo: How do you welcome these new health insurance sanctions against health centers suspected of fraud?
Dr. Thierry Bour: This is not very surprising because there have been investigations into Alliance Vision for about two years. They were denounced at the time to health insurance. These are multiple frauds with also the illegal practice of medicine, people who have made him come back in an unjustified way several times. The 20 million euros [de fraude estimée] that are announced are in my opinion the minimum. There are many other chains of health, dental or ophthalmological centers that are in the crosshairs. We can think that there will still be a few dozen deconventions of health centers.
It looks huge!
In ophthalmology, there were 80 centers before 2018, when the legislation was relaxed for the opening. Currently, it is between 230 and 250, and most of the centers that have opened are centers that have practices known to be fraudulent. One can legitimately think that once the investigations will have been completed, these centers will be deconventioned. The deconvention of the centers has only been possible since October 2022. And a law was passed in Parliament on May 19, which allows the ARS [agence régionale de santé] not to open centers or close centers that are fraudulent. The legislative and regulatory framework has changed a lot and now allows health insurance and the ARS to sanction them, which was not possible before.
Now that the law is here, do you expect things to go faster?
I think a lot of things will happen by the end of the year. There will be a complete restructuring of the health centers in the next two years, since the final agreement with the approval of the ARS should arrive by 2024-2025 for all the centers, including those that already exist.
Out of approximately 250 centers, how many could be perpetrators of fraud in your opinion?
According to health insurance, more than 150 have been checked and the checks are not random, it is following reports.
“There are reports that are linked to the fact that patients are complaining”
Dr Thierry Bour, from the National Union of Ophthalmologists of France (SNOF)at franceinfo
Other times, it is the health professionals who find themselves in unfair competition with these centers, but also more and more of the employees of these centers are scandalized by what they see in daily practices.
As health professionals, do you consider yourself victims of these frauds?
On the one hand, there is unfair competition compared to the 2,500 ophthalmological surgeries that operate normally. This gives a deplorable image of the profession, one has the impression that all the doctors do anything. For us, this is really serious and it seems that there are really professional scammers who have entered the system since 2018.
>> Health insurance fraud: a “record” of 315 million euros in 2022, warns its managing director
In these centres, it’s a bit like considering that all normal people are serious cases. Patients are billed, especially those for example who are 40 years old, who have children, who come for glasses, as if they had serious pathologies: this is an opportunity to have them come several times, to do acts that are not relevant, often by professionals who are not authorized to examine people. For example, orthoptists are passed off as doctors. This gives a really quite catastrophic impression of the profession.
What can you do at union level?
It was we who initially denounced these frauds which came to us from the members. Then, we actually have 27 criminal complaints. (…) We hope that this will quickly lead to convictions. We do not see how it could not succeed given the gravity of the facts. Some are professional scammers ready to go to litigation, who have organized their insolvency, so it is not going to be easy to recover money.